Lyonsgate Primary Campus Screening Form
This form must be completed every day, for each child, after 5:00 a.m. and before your child arrives at school. If this online form is not completed, parents or primary caregivers are required to answer all screening questions in person when dropping students off at Lyonsgate Montessori School's Primary campus.
Child's First Name:
Child's Last Name:
Name of parent/caregiver completing this screening form:
Does the child for whom you are completing this screening form , or any member of your household, have any of the following symptoms?
Check all that apply.
Fever (37.8C or higher)
Shortness of breath
New olfactory (loss of smell) or taste disorders
Runny nose/nasal congestion (except seasonal allergies, nasal drip, etc.)
Conjunctivitis (pink eye)
Lethargy/difficulty feeding in infants
Have you, your child, or any member of your household traveled outside of Canada or had close contact with anyone that has traveled outside of Canada in the last 14 days?
Have you, your child, or any member of your household been identified by a Public Health Unit as a close contact of a COVID-19 case in the last 14 days?
Have you, your child, or any member of your household had close contact with anyone with a respiratory illness in the last 14 days?
You are required read and acknowledge the text below.
If the answer to any of the above questions is "Yes," or if any of the listed symptoms are present, your child has failed the screening process and is not permitted to attend Lyonsgate Montessori School. If your child has failed the screening process, please contact your health care provider as well as Public Health at 905-974-9848, option 2, for testing. Please refer to the "End of Exclusion" section in the "Lyonsgate COVID-19 Exclusion of Sick Children/Staff Policy and Procedures" to see when ill children can return to school.
Yes, I acknowledge that I have read and understand the above text.
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This form was created inside of Lyonsgate Montessori School.